EVALUATION OF MODIFIED ALVARDO SYSTEM IN ACUTE APPENDICITIS IN TRIBAL POPULATION OF GUJARAT

Abstract

Clinical scoring systems, such as the Alvarado and modied Alvarado scoring systems, were developed with the goal of reducing the negative appendectomy rate to 5%–10%. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was established in 2008 specically for Asian populations. The aim of this study was to compare the modied Alvarado with the RIPASA scoring system.This study included 180 patients who underwent appendectomies and were documented as having “acute appendicitis” or “abdominal pain” in the operating theatre logbook (unit B).The sensitivity, specicity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic (ROC) curve of the modied Alvarado and RIPASA scoring systems were derived using SPSS statistical software.A total of 136 patients were included in this study according to our criteria. The cut-off threshold point of the modied Alvarado score was set at 7.0, which yielded a sensitivity of 82.8% and a specicity of 56%. The PPVwas 89.3% and the NPVwas 42.4%. The cut-off threshold point of the RIPASAscore was set at 7.5, which yielded a 94.5% sensitivity and an 88% specicity. The PPV was 97.2% and the NPV was 78.5%. The predicted negative appendectomy rates were 10.7% and 2.2% for the modied Alvarado and RIPASA scoring systems, respectively. The negative appendectomy rate decreased signicantly, from 18.4% to 10.7% for the modied Alvarado, and to 2.2% for the RIPASA scoring system, which was a signicant difference (P<0.001) for both scoring systems.Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specicity than the modied Alvarado scoring system in Asian populations. It consists of 14 clinical parameters that can be obtained from a good patient history, clinical examination and laboratory investigations.